Omnipod 5 Interest List

Please submit your details if you want to receive our news and marketing emails about the Omnipod® 5 Automated Insulin Delivery System and other Insulet products and services. You can unsubscribe from these emails at any time by clicking “unsubscribe” in any email you receive.

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First Name

Last Name

Type of Diabetes

Selection 1 Type 1

Selection 1 Type 2

Selection 1 Other/Unsure

Do you use the Dexcom G6 glucose sensor?

Selection 1 Yes

Selection 1 No

Are you currently using Omnipod®?

Selection 1 Yes

Selection 1 No

Email Address

Phone Number

How did you hear about Omnipod®?

Selection 1 I certify I am 18 years of age or older. If you are under 18, please ask your parent or guardian to complete on your behalf.

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